Journal of midwifery & women's health最新文献_第9页

Variation in the Use of Guideline-Based Care by Prenatal Site: Decomposing the Disparity in Preterm Birth for Non-Hispanic Black Women 产前地点使用指南护理的差异：分解非西班牙裔黑人妇女早产的差异。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-03-17 DOI: 10.1111/jmwh.13745

Patricia McGaughey CNM, MSN, PhD, Renata E. Howland PhD, MPH

Introduction

Despite longstanding status as a public health priority, preterm birth rates continue to be higher among non-Hispanic Black women compared with other racial and ethnic groups. A growing body of literature highlights the site of care as a key factor in pregnancy outcomes. Although research shows that many individuals do not receive guideline-based prenatal care, little is known about site-level variation in the use of recommended prenatal services and its potential relationship with Black-White preterm birth disparities.

Methods

In this cross-sectional cohort study, we analyzed variation in site-level use of 4 key prenatal services: tetanus, diphtheria, and pertussis (Tdap) vaccination, [per the CDC website] and screening for bacteriuria, diabetes, and group Beta streptococcus, using administrative data from New York State Medicaid and the American Community Survey. We used multivariable logistic regressions to estimate the odds of attending a low-use site (mean <2 services per patient) by race and ethnicity, controlling for age, high-poverty residential address, and low prenatal care attendance. We performed Fairlie decomposition analyses to quantify the contribution of individual and site-level factors to the observed difference in preterm birth rates among Black and White non-Hispanic women.

Results

Site-level use of recommended prenatal services ranged from an average of 1 to 3.6 services per patient. Non-Hispanic Black women had more than twice the odds (adjusted odds ratio, 2.42; 95% CI, 2.32-2.52) of attending a low-use site compared with non-Hispanic White women. Among factors in the decomposition analysis, site-level screening for bacteriuria and diabetes accounted for the highest proportion of the explained variance in the observed preterm birth rates for non-Hispanic Black (10.7%) and non-Hispanic White (6.7%) women.

Discussion

Results from this research support immediate improvement in guideline-based prenatal care to narrow the gap in preterm birth for non-Hispanic Black women. Research is needed to identify and correct site-level barriers to recommended prenatal services.

导言：尽管长期以来一直是公共卫生优先事项，但与其他种族和族裔群体相比，非西班牙裔黑人妇女的早产率仍然较高。越来越多的文献强调护理地点是影响妊娠结局的关键因素。尽管研究表明，许多人没有接受基于指南的产前护理，但对使用推荐产前服务的地点水平差异及其与黑人-白人早产差异的潜在关系知之甚少。方法：在这项横断面队列研究中，我们分析了4项关键产前服务在不同地点的使用变化：破伤风、白喉和百日咳（Tdap）疫苗接种，[根据CDC网站]以及细菌、糖尿病和β组链球菌筛查，使用来自纽约州医疗补助和美国社区调查的行政数据。我们使用多变量逻辑回归来估计到低使用率站点的几率(平均结果：站点水平推荐的产前服务的使用范围为每位患者平均1至3.6个服务。非西班牙裔黑人女性有两倍多的几率(调整后的优势比，2.42；95% CI, 2.32-2.52)，与非西班牙裔白人妇女相比，参加低使用率场所。在分解分析的因素中，对非西班牙裔黑人妇女（10.7%）和非西班牙裔白人妇女（6.7%）的观察到的早产率的解释差异中，细菌和糖尿病的现场水平筛查占最高比例。讨论：本研究结果支持立即改进基于指南的产前护理，以缩小非西班牙裔黑人妇女早产的差距。需要进行研究，以确定和纠正对所建议的产前服务的场所障碍。

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引用次数: 0

Feasibility of Remote Intensive Monitoring: A Novel Approach to Reduce Black Postpartum Maternal Cardiovascular Complications 远程强化监测的可行性：一种减少产后黑人产妇心血管并发症的新方法。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-02-26 DOI: 10.1111/jmwh.13743

Michelle Villegas-Downs PhD, RN, Tara A. Peters BS, CCRP, Jared Matthews MS, Anne M. Fink PhD, Alicia K. Matthews PhD, Judith Schlaeger CNM, PhD, LAc, Aiguo Han PhD, William D. O'Brien Jr PhD, Joan E. Briller MD, Woon-Hong Yeo PhD, Barbara L. McFarlin CNM, PhD, RDMS

Introduction

Approximately 53% of maternal mortality occurs in the postpartum period, a time with little monitoring and health surveillance. The objective of this study was to test the feasibility, usability, appropriateness, and acceptability of remote low-burden physiologic monitoring of Black postpartum women, using a novel soft wearable patch and home vital sign monitoring for the first 4 weeks postpartum.

Methods

A prospective longitudinal cohort feasibility study of 20 Black postpartum women was conducted using home monitoring equipment and a wearable patch with physiologic sensors measuring temperature, pulse oximetry, blood pressure, electrocardiogram (ECG), heart rate, and respiration twice daily during the first 4 weeks postpartum. Feasibility, acceptability, appropriateness, and usability were measured at the end of the study with the Feasibility of Intervention Measure, Acceptability of Intervention Measure, Intervention Appropriateness Measure, and System Usability Scale.

Results

Twenty Black women were recruited and consented to participate in the study. Remote physiologic monitoring using a wearable patch and home monitoring equipment was rated as feasible (93%), acceptable (93%), appropriate (92%), and useable (80%). During the first 2 weeks postpartum, remote home monitoring detected that 60% of the women had blood pressures exceeding 140/90 mm Hg. The wearable patch provided useable data on ECG, heart rate, heart rate variability, pulse oximetry, and temperature.

Discussion

Our research suggests that remote monitoring in the first 4 weeks postpartum has the potential to identify Black women at risk for postpartum complications.

导言：大约53%的产妇死亡发生在产后，这段时间很少受到监测和健康监测。本研究旨在探讨一种新型软性可穿戴贴片及产后4周家庭生命体征监测对黑人产后妇女进行远程低负荷生理监测的可行性、可用性、适宜性和可接受性。方法：对20名黑人产后妇女进行前瞻性纵向队列可行性研究，在产后4周内使用家庭监测设备和带有生理传感器的可穿戴贴片测量体温、脉搏血氧仪、血压、心电图、心率和呼吸，每天两次。可行性、可接受性、适当性和可用性在研究结束时用干预措施的可行性、干预措施的可接受性、干预适当性和系统可用性量表进行测量。结果：20名黑人女性被招募并同意参与研究。使用可穿戴贴片和家庭监测设备进行远程生理监测的评分为可行（93%）、可接受（93%）、适当（92%）和可用（80%）。在产后2周，远程家庭监测检测到60%的妇女血压超过140/90毫米汞柱。可穿戴贴片提供心电图、心率、心率变异性、脉搏血氧仪和体温的可用数据。讨论：我们的研究表明，产后前4周的远程监测有可能识别出有产后并发症风险的黑人妇女。

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引用次数: 0

Managing Bias in the Care of Pregnant and Parenting People with Substance Use Disorder 药物使用障碍孕妇和育儿者护理中的管理偏见。

IF 2.3 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-02-22 DOI: 10.1111/jmwh.13744

Briana E. Kramer CNM, MS, MPH, Nicole Warren CNM, PhD, MSN, Mishka Terplan MD, MPH, Andreea A. Creanga PhD, MD, Kelly M. Bower PhD, MSN, MPH, RN

Introduction

Unintentional overdose is the leading cause of pregnancy-associated death in Maryland and is preventable. Stigma contributes to birthing peoples’ disengagement with the health care system, and health care professionals may participate in stigmatizing processes. We aimed to develop and evaluate a training on stigma and bias related to substance use disorder (SUD) for maternal health care professionals in Maryland.

Methods

We used a community-engaged process to develop a training on stigma and bias related to SUD in pregnancy and implemented it with Maryland maternal health care professionals employed in birth hospital settings. We conducted a multimethod pre-post training evaluation, using a quantitative analysis of implementation reach, a pre-post knowledge test, a satisfaction survey, and a qualitative analysis of hospital facilitation meeting logs.

Results

The training was completed by 1145 health care professionals. Knowledge test scores increased significantly after training, with the greatest change noted in the safety of medications for opioid use disorder during pregnancy. Over 90% of participants found the training relevant and planned to actively use what they learned. Qualitative feedback indicated the training may increase empathy with the patient population and contribute to practice changes.

Discussion

Our evaluation suggests that this training is valuable, effective at increasing knowledge, and a potential catalyst for practice change among health care professionals working with pregnant and postpartum patients with SUD.

背景：意外用药过量是马里兰州妊娠相关死亡的主要原因，并且是可以预防的。污名化导致产妇脱离卫生保健系统，卫生保健专业人员可能参与污名化过程。我们旨在为马里兰州的孕产妇保健专业人员开发和评估与物质使用障碍（SUD）相关的耻辱和偏见培训。方法：我们采用社区参与的方法，对妊娠期与SUD相关的耻辱感和偏见进行培训，并在马里兰州分娩医院的孕产妇保健专业人员中实施。我们进行了一项多方法的培训前评估，使用了实施效果的定量分析、岗前知识测试、满意度调查和医院便利会议日志的定性分析。结果：有1145名卫生专业人员完成培训。培训后知识测试成绩显著提高，最大的变化是在怀孕期间阿片类药物使用障碍药物的安全性。超过90%的参与者认为培训是相关的，并计划积极使用他们所学到的知识。定性反馈表明，培训可能会增加对患者群体的同情，并有助于实践的改变。讨论：我们的评估表明，这种培训在增加知识方面是有价值的，有效的，并且是治疗妊娠和产后SUD患者的卫生保健专业人员实践变化的潜在催化剂。

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引用次数: 0

Exploring Midwives’ Experiences Within Canada's First Alongside Midwifery Unit: Impacts and Implications for Midwifery Practice 探索助产士的经验在加拿大第一个旁边助产单位：影响和影响助产实践。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-02-10 DOI: 10.1111/jmwh.13740

Beth Murray-Davis RM, PhD, Lindsay N. Grenier MA, Anne M. Malott RM, PhD, Cristina A. Mattison PhD, Carol Cameron RM, MA, Eileen K. Hutton PhD, Elizabeth K. Darling RM, PhD

Introduction

Although midwifery-led units in hospitals are associated with positive outcomes, little is known about the experiences of the midwives who work within this model. Despite the increase in midwifery-led units globally, the first unit of this kind opened its doors in Canada in 2018. The Alongside Midwifery Unit (AMU) is staffed by a hospitalist midwife (a novel role in this country) and community midwives, working in a caseload model, who attend their clients’ labor and birth on the unit. The AMU is a low-risk birthing unit located adjacent to the obstetric unit, offering midwifery-led care, in a homelike setting. Our aim was to explore and describe the experiences of midwives working in this model of care on the AMU.

Methods

Qualitative semistructured interviews and one focus group with community and hospitalist midwives working at the AMU were conducted and analyzed using a grounded theory approach.

Results

We identified that midwives were able to maintain the midwifery philosophy of care, strengthen relationships, amplify hospital integration, and grow midwifery leadership in this model.

Discussion

Implementation of an AMU supports best practice, intra- and interprofessional relationships, and integration of midwives. Our findings demonstrate a positive impact of this model along with the absence of detrimental impact on midwifery values and philosophy. An improved understanding of the impact of the AMU on midwives and their practice is useful for refining the model of care and informing implementation in other settings. This research contributes to the growing evidence demonstrating the benefits of midwifery-led units.

导言：尽管助产士主导的医院单位与积极的结果相关，但人们对在这种模式下工作的助产士的经历知之甚少。尽管全球由助产士主导的单位越来越多，但 2018 年，加拿大还是开设了首个此类单位。并肩助产病房（AMU）由一名医院助产士（这在加拿大是一个新角色）和社区助产士组成，她们以个案模式工作，在病房内为客户接生。助产病房是一个低风险的分娩病房，毗邻产科病房，在家庭式的环境中提供以助产士为主导的护理服务。我们的目的是探索和描述助产士在 AMU 这种护理模式下的工作经验：方法：我们对在急诊室工作的社区助产士和医院助产士进行了半结构式定性访谈和一次焦点小组讨论，并采用基础理论方法对访谈结果进行了分析：结果：我们发现助产士能够在这一模式中保持助产士的护理理念、加强关系、扩大医院整合以及提高助产士的领导力：讨论：AMU 的实施支持最佳实践、专业内和专业间的关系以及助产士的整合。我们的研究结果表明，这种模式具有积极影响，对助产士的价值观和理念没有不利影响。更好地了解助产病房对助产士及其实践的影响有助于完善护理模式，并为在其他环境中的实施提供参考。这项研究为越来越多的证据表明助产士主导单元的益处做出了贡献。

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引用次数: 0

The OptiBreech Trial Feasibility Study: A Qualitative Inventory of the Roles and Responsibilities of Breech Specialist Midwives OptiBreech试验可行性研究：臀位专科助产士角色和职责的定性清单。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-02-01 DOI: 10.1111/jmwh.13728

Siân M. Davies MSc, Alice Hodder BSc, Shawn Walker PhD, Natasha Bale MSc, Honor Vincent MA, Tisha Dasgupta MSc, Alexandra Birch MSc, Keelie Piper, Sergio A. Silverio MSc

Background

The safety of vaginal breech birth is associated with the skill and experience of professionals in attendance, but minimal training opportunities exist. OptiBreech collaborative care is an evidence-based care bundle, based on previous research. This care pathway is designed to improve access to care and the safety of vaginal breech births, when they occur, through dedicated breech clinics and intrapartum support. This improved process also enhances professional training. Care coordination is accomplished in most cases by a key breech specialist midwife on the team. The goal of this qualitative inventory was to describe the roles and tasks undertaken by specialist midwives in the OptiBreech care implementation feasibility study.

Methods

Semistructured interviews were conducted with OptiBreech team members (17 midwives and 4 obstetricians; N = 21), via video conferencing software. Template analysis was used to code, analyze, and interpret data relating to the roles of the midwives delivering breech services. Tasks identified through initial coding were organized into 5 key themes in a template, following reflective discussion at weekly staff meetings and stakeholder events. This template was then applied to all interviews to structure the analysis.

Results

Breech specialist midwives functioned as change agents. In each setting, they fulfilled similar roles to support their teams, whether this role was formally recognized or not. We report an inventory of tasks performed by breech specialist midwives, organized into 5 themes: care coordination and planning, service development, clinical care delivery, education and training, and research.

Discussion

Breech specialist midwives perform a consistent set of roles and responsibilities to co-ordinate care throughout the OptiBreech pathway. The inventory has been formally incorporated into the OptiBreech collaborative care logic model. This detailed description can be used by employers and professional organizations who wish to formalize similar roles to meet consistent standards and improve care.

背景：阴道臀位分娩的安全性与在场专业人员的技能和经验有关，但培训机会很少。OptiBreech协作护理是基于先前研究的循证护理包。这一护理途径旨在通过专门的臀位诊所和产时支持，改善阴道臀位分娩的护理和安全性。这种改进的过程也加强了专业培训。在大多数情况下，护理协调由团队中的关键臀位专家助产士完成。该定性调查的目的是描述专业助产士在OptiBreech护理实施可行性研究中的角色和任务。方法：对OptiBreech团队成员(17名助产士和4名产科医生；N = 21)，通过视频会议软件。模板分析用于编码、分析和解释与提供臀位服务的助产士角色相关的数据。通过初始编码确定的任务在一个模板中被组织成5个关键主题，并在每周员工会议和利益相关者活动中进行反思讨论。然后将此模板应用于所有访谈以构建分析。结果：臀位专科助产士发挥了变革推动者的作用。在每一种情况下，他们都扮演类似的角色来支持他们的团队，不管这个角色是否被正式认可。我们报告了臀位专科助产士执行的任务清单，分为5个主题：护理协调和规划、服务发展、临床护理交付、教育和培训以及研究。讨论：臀位专科助产士执行一套一致的角色和责任，以协调整个OptiBreech途径的护理。该清单已正式纳入OptiBreech协同护理逻辑模型。这个详细的描述可以被雇主和专业组织使用，他们希望将类似的角色正式化，以达到一致的标准并改善护理。

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引用次数: 0

Mothers’ Experiences of Institutional Betrayal During Childbirth and their Postpartum Mental Health Outcomes: Evidence From a Survey of New Mothers in the United States 母亲在分娩过程中的制度背叛经历及其产后心理健康结果：来自美国新妈妈调查的证据。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-01-29 DOI: 10.1111/jmwh.13725

Manali Kulkarni MS, Priya Fielding-Singh PhD

Introduction

The purpose of this descriptive study was to explore the relationship between the experience of institutional betrayal (IB) during childbirth and postpartum mental health.

Methods

Women who had given birth within the last 3 years in the United States as of June 2021 were recruited via Qualtrics to complete an online survey. Participants (N = 588) answered questions about their birth experiences, including adverse medical events and experiences of IB. Multiple logistic regressions examined whether experiencing one or more types of IB was associated with receiving a diagnosis of a postpartum mental health condition, controlling for other theoretically relevant covariates.

Results

More than one-third (39%) of respondents experienced one or more types of IB during childbirth, with a mean (SD) of 1.7 (0.47) and maximum of 2. Experiencing IB increased the odds of a postpartum mental health condition diagnosis by 2.86 (95% CI, 1.63-5.05; P < .001).

Discussion

The findings suggest that experiencing IB may be one mechanism driving negative postpartum mental health outcomes. Health care providers and policymakers should be aware of the role that IB can play in women's birth experiences and consider how strategies to decrease instances of IB during childbirth may improve postpartum mental health.

前言：本研究旨在探讨分娩期间机构背叛经历与产后心理健康之间的关系。方法：截至2021年6月，通过Qualtrics招募了过去三年内在美国分娩的妇女完成在线调查。参与者（N = 588）回答了有关其出生经历的问题，包括不良医疗事件和IB经历。多重逻辑回归检验了经历一种或多种IB类型是否与接受产后心理健康状况诊断相关，控制了其他理论相关的共变量。结果：超过三分之一（39%）的受访者在分娩期间经历了一种或多种类型的IB，平均（SD）为1.7(0.47)，最大值为2。经历IB使产后心理健康状况诊断的几率增加了2.86 (95% CI, 1.63-5.05；讨论：研究结果表明，经历IB可能是导致产后负面心理健康结果的一种机制。卫生保健提供者和政策制定者应该意识到IB在妇女分娩经历中的作用，并考虑减少分娩期间IB病例的策略如何改善产后心理健康。

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引用次数: 0

Taking Care of Your Mental Health 照顾好你的心理健康

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-01-23 DOI: 10.1111/jmwh.13735

Mental health is how you think, feel, act, and handle emotions. It includes your psychological, emotional, and social well-being. Your mental health affects your physical health, relationships, and ability to do daily activities. It influences how you cope with life and stress, learn and work, and make decisions. Taking care of your mental health is important for staying healthy, having good relationships, handling stress well, and adapting to change and difficult times.

If you are experiencing times of stress or loss, consider working with a mental health professional especially if you are having trouble performing your daily activities. Talk to your health care provider if you are experiencing any of the above symptoms. They may recommend talk therapy and/or medication. Insurance often pays for access to therapy. If you have thoughts of hurting yourself or someone else, get help right away. Go to the closest emergency room or call 911. You can also call the National Suicide Prevention Lifeline 24 hours a day at 1-800-273-TALK (8255), or the Suicide and Crisis Lifeline 988 available in English or Spanish.

Flesch Kincaid reading level 6.8

Approved December 2024.

This handout may be reproduced for noncommercial use by health care professionals to share with patients, but modifications to the handout are not permitted. The information and recommendations in this handout are not a substitute for health care. Consult your health care provider for information specific to you and your health.

心理健康是指你如何思考、感受、行动和处理情绪。它包括你的心理、情感和社会福利。你的心理健康会影响你的身体健康、人际关系和日常活动的能力。它会影响你如何应对生活和压力，如何学习和工作，以及如何做决定。照顾好你的心理健康对于保持健康、拥有良好的人际关系、处理好压力、适应变化和困难时期都很重要。如果你正在经历压力或失落的时刻，考虑与心理健康专家合作，特别是如果你在日常活动中遇到麻烦。如果您出现上述任何症状，请咨询您的医疗保健提供者。他们可能会建议谈话治疗和/或药物治疗。保险通常会支付治疗费用。如果你有伤害自己或他人的想法，立即寻求帮助。去最近的急诊室或打911。你也可以每天24小时拨打全国预防自杀生命线1-800-273-TALK(8255)，或自杀和危机生命线988（英语或西班牙语）。2024年12月批准。本讲义可以复制用于非商业用途，供卫生保健专业人员与患者分享，但不允许对讲义进行修改。本讲义中的信息和建议不能替代医疗保健。向您的医疗保健提供者咨询有关您和您的健康的具体信息。

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引用次数: 0

Index of ACNM Documents and Publications, January 2025 ACNM文件和出版物索引，2025年1月

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-01-20 DOI: 10.1111/jmwh.13737

引用次数: 0

An Interprofessional Collaboration Between a Community-Based Doula Organization and Clinical Partners: The Champion Dyad Initiative 以社区为基础的导乐组织和临床合作伙伴之间的跨专业合作：冠军Dyad倡议。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-01-18 DOI: 10.1111/jmwh.13730

Cassondra Marshall DrPH, MPH, Ashley Nguyen MPH, Alli Cuentos , Alyana Almenar MPH, Gabriella Mace MPH, Jennet Arcara PhD, MPH, MPP, Andrea V. Jackson MD, MAS, Anu Manchikanti Gómez PhD, MSc

As access to doula services expands through state Medicaid coverage and specific initiatives aimed at improving maternal health equity, there is a need to build and improve upon relationships between the doula community, hospital leaders, and clinical staff. Previous research and reports suggest rapport-building, provider education, and forming partnerships between community-based organizations and hospitals can improve such relationships. However, few interventions or programs incorporating such approaches are described in the literature. This article describes the development and 5 core components of the Champion Dyad Initiative (CDI), a novel program that uses bidirectional feedback between SisterWeb, a community-based doula organization, and 5 clinical sites (4 hospitals and one birthing center) to ensure pregnant and birthing people receive fair and equitable treatment. We also describe implementation challenges related to documentation, funding, and institutional support. The CDI is a promising model for community-based doula organizations and health care institutions to develop collaborative partnerships, build respectful doula-provider relationships, and work toward improving the pregnancy-related care that Black, Indigenous, and people of color receive in hospital and birth center settings. It is our hope that this innovative initiative can serve as a model that can be adapted for other locales, organizations, and hospitals.

随着州医疗补助覆盖范围和旨在改善孕产妇保健公平的具体举措扩大了助产师服务的覆盖面，有必要建立和改善助产师社区、医院领导和临床工作人员之间的关系。以前的研究和报告表明，在社区组织和医院之间建立融洽关系、提供者教育和建立伙伴关系可以改善这种关系。然而，文献中很少描述纳入此类方法的干预措施或方案。本文介绍了Champion Dyad Initiative （CDI）的发展及其5个核心组成部分。CDI是一个新颖的项目，利用SisterWeb（一个以社区为基础的助产师组织）和5个临床站点（4家医院和1家分娩中心）之间的双向反馈，确保怀孕和分娩的人得到公平和公平的治疗。我们还描述了与文档、资金和机构支持相关的实现挑战。CDI是社区助产师组织和卫生保健机构发展合作伙伴关系、建立相互尊重的助产师-提供者关系以及努力改善医院和生育中心环境中黑人、土著和有色人种获得的与妊娠有关的护理的一个有前途的模式。我们希望这一创新举措可以成为其他地区、组织和医院的典范。

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引用次数: 0

Perinatal Suicide 围产期自杀。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2025-01-18 DOI: 10.1111/jmwh.13738

Pamela J. Reis CNM, PhD

<p>The tragedy of preventable perinatal deaths among birthing people continues to take its toll on our nation. This includes death by suicide during the perinatal period as a profound and leading cause of maternal mortality. Mental health disorders are the leading cause of maternal mortality in the United States according to the most recent data from the Centers for Disease Control and Prevention (CDC).<span><sup>1</sup></span> The CDC defines deaths due to mental health conditions as those because of suicide, overdose, or drug poisoning related to substance use disorder (SUD), and other deaths determined by morbidity and mortality review committees to be related to a mental health condition, including SUD.<span><sup>2</sup></span> Suicide during the perinatal period accounts for approximately 7% of deaths during pregnancy and 20% of postpartum deaths, shockingly surpassing death by postpartum hemorrhage or hypertensive disorders.<span><sup>3</sup></span> The purpose of this commentary is to highlight current literature in perinatal suicide and to provide guidance and resources for clinicians.</p><p>Pregnancy-related deaths because of mental health conditions are described as any death due to a maternal health condition, such as depression or other psychiatric illnesses and SUD and drug overdose (intentional or not intentional). Death by suicide includes unintentional and accidental drug overdose, as well as instances for which the intent to die by suicide is known.<span><sup>2</sup></span></p><p>It is not uncommon for mental health disorders such as depression, anxiety, and bipolar disorder to begin or worsen during pregnancy and the postpartum period.<span><sup>4</sup></span> The spectrum of suicide disorders is more prevalent among birthing people with a history of depression or bipolar disorder.<span><sup>4</sup></span> The <i>Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition</i> (<i>DSM-5</i>) published in 2013, introduced suicidal behavior disorder (SBD) under conditions for further study, defining SBD as a self-initiated sequence of behaviors leading to one's own death within the previous 24-month period.<span><sup>5</sup></span> Unfortunately, the clinical usage of the definition of SBD for predicting death by suicide has not resulted in a decrease in suicide, and the diagnosis and manifestations of SBD and its association with suicidal ideation and other self-harming behaviors is unclear. The American Psychiatric Association's latest release, the <i>DSM-5-Text Revision</i>, published in 2022, did not elaborate on the SBD diagnosis in a manner that clinicians and researchers found especially useful, and was ultimately moved from Conditions for Further Study to Other Conditions That May Be a Focus of Clinical Attention. The rationale for this change was that suicide did not strictly meet the criteria for a mental health disorder, but instead was a behavior with diverse causes.<span><sup>5</sup></span></p><p>Determining t

产妇可预防的围产期死亡悲剧继续给我国造成损失。这包括围产期自杀死亡，这是孕产妇死亡的一个深刻和主要原因。根据疾病控制和预防中心（CDC）的最新数据，精神健康障碍是美国孕产妇死亡的主要原因美国疾病控制与预防中心将精神健康状况导致的死亡定义为与物质使用障碍（SUD）有关的自杀、过量或药物中毒，以及由发病率和死亡率审查委员会确定的与精神健康状况有关的其他死亡，包括SUD。2围产期自杀约占怀孕期间死亡的7%，占产后死亡的20%，惊人地超过产后出血或高血压疾病导致的死亡本评论的目的是突出当前的文献围产期自杀和提供指导和资源，为临床医生。由于心理健康状况导致的与怀孕有关的死亡被描述为由于产妇健康状况导致的任何死亡，例如抑郁症或其他精神疾病以及SUD和药物过量（有意或无意）。自杀死亡包括无意和意外用药过量，以及已知意图自杀的情况。精神健康障碍如抑郁、焦虑和双相情感障碍在怀孕和产后期间开始或恶化并不罕见自杀障碍在有抑郁症或双相情感障碍病史的产妇中更为普遍2013年出版的《精神疾病诊断与统计手册》第五版（DSM-5）将自杀行为障碍（SBD）纳入了进一步研究的条件，并将其定义为在过去24个月内导致自己死亡的一系列自我发起的行为不幸的是，临床上使用SBD的定义来预测自杀死亡并没有导致自杀的减少，而且SBD的诊断和表现及其与自杀意念和其他自残行为的关系尚不清楚。美国精神病学协会（American Psychiatric Association）于2022年出版的最新版本DSM-5-Text Revision，并没有以临床医生和研究人员认为特别有用的方式详细说明SBD的诊断，最终从“进一步研究的条件”移到了“可能是临床关注焦点的其他条件”。这一变化的基本原理是，自杀并不严格符合精神健康障碍的标准，而是一种有多种原因的行为。5 .确定因自杀导致的围产期死亡的发生率具有挑战性，研究正在不断发展，以了解这种灾难性后果的风险和可能的预防措施。疾病预防控制中心从国际疾病统计分类代码中提取数据，以确定围产期死亡的潜在原因。直到最近，围产期自杀以及药物过量或中毒死亡才被纳入与妊娠有关的孕产妇死亡统计。虽然提高了对围产期自杀的警惕，但结果表明，当围产期的定义延长到产后1年时，报告的孕产妇自杀死亡人数显著增加。6 .在确定自杀是围产期死亡原因方面，死亡证明一直是一项挑战。尽管2003年修订的美国标准死亡证书在死亡证明中增加了怀孕复选框，但报告错误仍然经常被发现自杀死亡的鉴定通常需要额外的监测，如尸检、死后妊娠检查和门诊精神健康记录。围产期自杀死亡率的种族和民族差异很难量化，因为样本很小，而且倾向于将一些种族或民族（如美洲原住民）分类为其他种族或民族漏报严重影响了这些重要人口统计数据的收集。然而，研究表明，非西班牙裔黑人妇女比其他种族和民族的妇女有更高的自杀风险据观察，报告自己种族为其他种族的妇女在产后出现自杀意念的可能性大约是白人的3倍。先前的研究表明，怀孕、分娩和产后会诱发对自杀意念有保护作用的情绪。然而，不断发展的围产期自杀研究否定了这一观点。Chin等人3通过回顾当前专门关注产妇自杀的文献，研究了自杀行为的患病率及其相关因素。总的来说，作者发现围产期自杀死亡的流行程度各不相同，据报道，在妊娠中期和晚期，自杀行为的发生率更高。根据文献综述，Chin等人3发现，大多数自杀发生在围产期后期，即妊娠结束后43至365天之间。出生后严重的精神健康障碍和有自残史是产后自杀的高危因素产后是自杀的高危期。据估计，高达75%的围产期自杀死亡发生在分娩后6周至1年内Chin等人在他们的文献综述中观察到，非西班牙裔黑人女性有自杀想法和意图的风险最高。筛查抑郁、焦虑和其他围产期情绪障碍已被确立为最佳实践和循证临床护理。然而，关于自杀的常规筛查仍然缺乏共识。2023年6月，美国预防服务工作组发布了一项针对所有成年人的抑郁症和自杀筛查建议。尽管建议对所有成年人进行抑郁症筛查，但工作组得出结论，目前的证据不足以评估对成年人（包括孕妇和产后人群）进行自杀风险筛查的利弊平衡。病人健康问卷（PHQ）和爱丁堡怀孕/产后抑郁量表都包含一个关于自杀念头的问题。然而，有自杀念头并不一定意味着一个人即将面临自杀死亡的风险，这使得筛查过程更具挑战性。自杀意念包括侵入性的想法和沉思，以及对死亡和自杀的关注。消极的自杀意念是关于无用和死亡的想法，但没有结束自己生命的计划。主动自杀意念是指带有伤害自己的计划或意图的自杀想法。10 .围产期自杀的风险有：个人或家族史或当前诊断为抑郁症或焦虑症，精神科住院治疗，突然停药，自杀意念和自杀企图史，SUD（既往或当前），流产，意外怀孕，受教育程度有限，低收入家庭，亲密伴侣虐待，童年不良经历史，包括强奸，低社会支持，年龄40岁及以上或小于20岁。“零自杀”是由2012年国家预防自杀战略首先制定的一个包含7个要素的变革性安全护理模式。该模型的前提是，所有遇到医疗服务提供者的个人都应该接受自杀风险筛查。零自杀模式和框架是由教育发展中心开发的，这是一个非营利性组织，旨在促进改善教育、健康和经济机会的持久解决方案“零自杀”被国家自杀预防行动联盟和自杀预防资源中心（教育发展中心的一个项目）采纳为优先事项。“零自杀”的目的是使行为卫生保健系统和所有向有行为卫生需求的个人提供护理的实体能够采用最有效、数据知情和循证的自杀护理做法。该模型建议各系统采用零基础思维，定期和持续地采用以患者安全为重点的循证实践，并为有自杀风险的人带来希望和康复。该模型强调，直接询问自杀问题并作出适当回应，应该像在每次医疗访问中获得生命体征一样成为常规该模型的7个要素是：(1)领导致力于减少自杀的全系统变革；(2)培训有能力和富有同情心的员工队伍；(3)通过全面筛查和评估识别有自杀风险的个体；(4)使用自杀护理管理计划吸引所有有自杀风险的个体；(5)使用循证治疗和策略治疗有自杀风险的个体；(7)通过持续的质量改进改进政策和流程。个别组织使用零自杀框架和工具包，根据其人口和社区开发定制的自杀识别和意识项目。关于零自杀框架有效性的研究证据很少，而且仍在不断发展。Stapelberg等人12在澳大利亚一家大型精神卫生服务机构实施零自杀框架后对其进行了评估。

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